Louisiana State University LSU Digital Commons LSU Historical Dissertations and eses Graduate School 1971 Performance of Acute Paranoid and Non-Paranoid Schizophrenic Patients on the Halstead-Reitan Baery Using Two Levels of Symptomatology. James omas Stack Louisiana State University and Agricultural & Mechanical College Follow this and additional works at: hps://digitalcommons.lsu.edu/gradschool_disstheses is Dissertation is brought to you for free and open access by the Graduate School at LSU Digital Commons. It has been accepted for inclusion in LSU Historical Dissertations and eses by an authorized administrator of LSU Digital Commons. For more information, please contact [email protected]. Recommended Citation Stack, James omas, "Performance of Acute Paranoid and Non-Paranoid Schizophrenic Patients on the Halstead-Reitan Baery Using Two Levels of Symptomatology." (1971). LSU Historical Dissertations and eses. 2011. hps://digitalcommons.lsu.edu/gradschool_disstheses/2011
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Louisiana State UniversityLSU Digital Commons
LSU Historical Dissertations and Theses Graduate School
1971
Performance of Acute Paranoid and Non-ParanoidSchizophrenic Patients on the Halstead-ReitanBattery Using Two Levels of Symptomatology.James Thomas StackLouisiana State University and Agricultural & Mechanical College
Follow this and additional works at: https://digitalcommons.lsu.edu/gradschool_disstheses
This Dissertation is brought to you for free and open access by the Graduate School at LSU Digital Commons. It has been accepted for inclusion inLSU Historical Dissertations and Theses by an authorized administrator of LSU Digital Commons. For more information, please [email protected].
Recommended CitationStack, James Thomas, "Performance of Acute Paranoid and Non-Paranoid Schizophrenic Patients on the Halstead-Reitan BatteryUsing Two Levels of Symptomatology." (1971). LSU Historical Dissertations and Theses. 2011.https://digitalcommons.lsu.edu/gradschool_disstheses/2011
STACK, Janes Thoaas, 1940-PERFORMANCE OF ACUTE PARANOID AND NON-PARANOID SCHIZOPHRENIC PATIENTS ON THE HALSTEAD-REITAN BATTERY USING TWO LEVELS OF SYMPTOMATOLOGY.The Louisiana State University and Agricultural and Mechanical College, Ph.D., 1971 Psychology, clinical
University Microfilms, A XEROX Com pany , Ann Arbor, M ichigan
THIS DISSERTATION HAS BEEN MICROFILMED EXACTLY AS RECEIVED
PERFORMANCE OF ACUTE PARANOID AND NON-PARANOID SCHIZOPHRENIC
PATIENTS ON THE HALSTEAD-REITAN BATTERY USING TWO
LEVELS OF SYMPTOMATOLOGY
A Dissertation
Submitted to the Graduate Faculty of the Louisiana State University and
Agricultural and Mechanical College in partial fulfillment of the requirements for the degree of
Master of Arts
in
The Department of Psychology
b y 1 James Tl Stack
B,A., University of North Carolina, 1962 M.A., Louisiana State University, 1968
May, 1971
ACKNOWLEDGMENTS
The author would first like to acknowledge his family and
particularly his wife, Helen, for her unfailing support and love
throughout his five years of graduate school. And also for the
many times that she contributed her typing skills at unreasonable
hours. Secondly, he would like to thank his children Jennifer and
Charlie for being a constant source of warmth and motivation towards
completing this dissertation.
I would like to express my gratitude to the members of my
dissertation committee. Special thanks is due to Dr. Joseph G.
Dawson for his support and help during innumerable crlslses.
Similar thanks goes to Dr, Donald Glad for his friendship which
manifests itself in the latter part of my graduate career. Also
thanks are in order for Dr. Yang who always had a friendly smile and
made himself available with little notice as a member of the committee.
Appreciation goes to Dr. Lyle Miller who served as a critical advisor
and excellent model of what an industrious scientist can accomplish.
Finally thanks go to Dr. Vernon Parenton for his friendship and
emphaslB on the value of historical perspective.
In addition acknowledgment of the help of many people asso
ciated with the Veterans Administration Hospital in New Orleans,
Louisiana, is most appropriate. Particularly, this is the case with
Dr. Herdis Deabler who gave much administrative assistance and was
instrumental in obtaining the grant that funded this particular
ii
project. Many other people at the VA were especially helpful in terms
of emotional support and the actual obtaining of subjects. Among these
persons were Dr. Allan Phillips, Dr. Kaufmann, George Henderson, Eve
Hewes, and Art Schueneman. In addition, the statistical advice of Dr.
Kenneth Edwards and Dr. Fred Flick was invaluable. A special debt is
owed to Miss Beverly Bruce who did most of the difficult testing and
somehow managed to put up with my distress over testing patients.
Finally, thanks are in order for Mrs. Mevers who has assisted me on
so many occasions during my graduate work and for her preparation of
this manuscript.
ill
TABLE OF CONTENTS
Page
TITLE P A G E ........................................................ 1
ACKNOWLEDGMENTS.................................................... ii
LIST OF T A B L E S .................................................... v
LIST OF FIGURES.................................................... vi
ting superiority of paranoids over nonparanoids on such diverse tasks
as tapping speed, hand steadiness, Rorschach genetic level, double
alternation learning and conditioning. The Johannsen research was
particularly interesting because the paranoid-nonparanoid dimension was
found to be unrelated to the process-reactive, acute-chronic, or good-
poor premorbld dimensions. Thus it appezrs that the paranoid-non-
paranoid dimension is a meaningful way to divide schizophrenic patients
into groups.A second potentially appropriate dimension for subdividing
schizophrenic populations for studying psychological deficits is that
13
of severity of psychopathology. Lang and Buss (1965) noted that there
was ample evidence that severity of psychopathology and psychological
deficit were positively related. Similarly Smith and Boyce (1962) have
suggested that psychiatric symptomatology is related to psychological
deficit. Utilizing the MMPI as a measure of psychopathology they found
that three psychotic scales (Pa, Sc, and Ma) were positively correlated
to a poor performance on the Trail-Making Test,
In summary, those who accept interference theory do not view
schizophrenia as a homogenous entity. Therefore, in their investiga
tions of the psychological deficits found in the disorder other poten
tial variables such as type and degree of psychopathology were
considered,
Statement of the Problem
Preliminary studies have indicated that the validity of the
Halstead-Reitan battery may suffer when used with psychiatric popula
tions (Brown, ,et a_l.j 1958, L'Bate, et al,, 1962, and Orgel and
McDonald, 1967). Other investigators such as Alvarez (1962) who
studied depressed patients have not found that psychiatric problems
have influenced the scores. However, all the above mentioned investi
gators utilized only one subtest of the Halstead-Reitan battery, the
Trail-Making Test. Matthews, at al. (1966) using the entire Halstead-
Reitan battery reported that it significantly differentiated between a
brain-damaged group and a group composed entirely of psychiatric dis
orders. Unfortunately their psychiatric group contained eight differ
ent diagnostic categories. Because of the small number of cases
14
involved no attempt was made to analyze subgroups separately.
To date there are only two studies which have utilized the
entire Halstead-Reitan battery with schizophrenic patients (Levine and
Fairstein, 1965, and Watson, et ill. , 1968) and these two studies pro
duced contradictory results. Specific details of Levine and Fairstein's
study are somewhat obscure because the study was not published. They
compared brain-damaged patients and schizophrenic patients in a
general medical and surgical hospital. Levine and Fairstein found
that certain subtests on the Halstead-Reitan battery were able to dis
criminate between the schizophrenic and brain-damaged patients. Watson,
et a 1. (1968) reported Levine and Fairstein excluded certain highly
psychotic patients and brain-damaged patients with unilateral lesions.
No further information was available regarding the specific sampling
procedures u.’ed in the Levine and Fairstein study. Watson, £lt _al. (1968)
compared a relatively chronic population of schizophrenic and brain
damaged patients and concluded that the Halstead-Reitan battery had no
validity in the differentiation of schizophrenic and brain-damaged
patients. Part of Watson's conclusion that the battery had little
validity was based on a strict adherence to Reitan's cut-off points for
a normal population. No appropriate control population was used in
either the Levine and Fairstein or Watson study. Furthermore, in neither
study was any data given regarding other factors which could have led to
a poor performance by the schizophrenic patient. There was no mention
in the Watson and Thomas study about how many schizophrenic patients had
received extensive or recent EST. Although research on the effects of
15
EST has not been definitive there Is reason to believe that it may pro
duce lasting effects (Heilbrunn and Liebert, 1941). The memory problems
associated with recent EST are all too evident. Also there was no men
tion of how many of the schizophrenic patients had been diagnosed as
alcoholic or who had clinical histories of heavy drinking. Thompson
(1959) as well as others has noted that high alcohol consumption can
lead to a variety of cognitive and perceptual deficits.
Finally there was no mention of whether schizophrenic patients
had received recent medical examinations to screen for potential neuro
logical problems such as head trauma. It is quite possible that these
omissions could have contaminated their results and led to extremely
poor perftprmance of the schizophrenic patients.
In addition to the above mentioned criticisms it is believed
that the sample of schizophrenic patients studied by Watson and Thomas
had certain unique features which could have significantly influenced
their results. The schizophrenic patients sampled were quite dissimilar
in terms of chroniclty as compared to schizophrenic patients in a
general medical and surgfcal hospital such as the Veterans Administra
tion Hospital in New Orleans. In Watson's study schizophrenic patients
classified as recent admissions had a total mean length of NF hospi
talization of 13.9 months. Schizophrenic patients classified as old
admissions had a mean length of hospitalization of 134 months. It has
been the present investigator's experience that often strictly Neuro-
psychiatric Veterans Administration hospitals are the recipients of
schizophrenic patients who for a variety of reasons such as belligerence,
16
severity of symptoms, etc., have been transferred from short-term treatment settings such as represented by the Veterans Administration Hospital in New Orleans. The fact that the schizophrenic patients in the
Watson study had been hospitalized for relatively long periods of time may have biased their sample with regard to two other dimensions that
have been related to psychological deficit in schizophrenia. First their sample may have been composed of a disproportionate number of
schizophrenic patients that would have been labeled process or nuclear schizophrenics. Stephens and Astrop (1963) demonstrated that schizo
phrenic patients classified as process showed much poorer recovery rates. A similar phenomenon could have occurred with the dimension of
paranoid vs. nonparanoid schizophrenia, Sommers and Witney (1961)
found that most of the patients who became chronic were nonparanoid. Twice as many paranoid schizophrenic patients were discharged as any
other kind of schizophrenic.The present Investigator believed that the Ha 1stead-Reitan
battery was particularly worthy of exhaustive evaluation because of its
extremely high validity with regard to the diagnosis of brain damage.It is apparent that the Halstead-Reitan battery is becoming Increasingly
used in psychiatric settings though its validity in these settings is
questionable. Previous research on the battery has primarily investi
gated factors within the context of brain damage. Information of effects of functional psychiatric disorders such as schizophrenia has
not been available.The present investigation was designed to answer the following
17
basic questions: In all the subsequent analysis a significant multi
variate F at the .05 level was set as a criterion for rejecting the
hypothesis that the pattern of scores for the groups were the same
(Clyde, 1969). Also in each case a series of Univariate F teBts were
conducted to ascertain which specific scores were responsible for the
difference in pattern. A significant univariate F at the .05 level was
set as a criterion for rejecting the hypothesis that a score was the
same for any given group.
1. Does the pattern of scores on the Halstead-Reitan battery differ
for medical control patients and the brain-damaged patients? It was
hypothesized that the two groups would have significantly different
patterns and that these differences would be present on all subtests of
the battery.
2. Does the pattern of scores on the Halstead-Reitan battery differ for
medical control patients and schizophrenic patients? It was hypothesized
that the two groups would not be significantly different in overall
pattern of scores, though It was anticipated that these differences
would approach significance. Expectations of significant Individual
score differences were based on interference theory. These predictions
were not intended to serve as a definitive validation of this particular
theory of psychological deficit in schizophrenia, but rather as logical
results in line with the theory. Hypothesized results on the individual
tests on the Halstead-Reitan battery were as follows:
Category Test. Inference theory would postulate that a schizophrenic
patient when faced with such a task as the category test cannot
18
maintain attention in any sustained fashion, maintain set, or change set
quickly when necessary. Furthermore this test presented subject with
numerous irrelevant cues that must be analyzed and ignored if any
adequate performance is to be achieved. Chapman (1956) has shown that
schizophrenic patients were overly susceptible to distractor cues which
are an inherent part of the category test. In a similar vein Cameron
(1938) believed that schizophrenic patients were characterized by
"asyndetic" thinking and "metonymic" distortion. By asyndetic thinking
Cameron referred to their inability to achieve integrated concepts. In
metonymic distortion an approximate or related term is substituted for
a more precise term. In terms of the category test one would expect
schizophrenic patients to only approach an integrated concept and lack
precision of definition in terms of their conceptualization of the
concept. Because the category test appeared to tap the essence of the
schizophrenic patient's thought disorder it is nypothesized that their
performance will be the most deficient on the category test relative to
other subtests of the battery and will be significantly poorer than the
medical patients.
Tactual Performance Test (TPT). It is hypothesized that the complexity
of modalities inherent in the TFT will lead to a significantly deficient
performance by schizophrenic patients when compared to the medical
patients. Interference theory would postulate that the degree of psycho
logical deficit manifested by the schizophrenic patient would be maxi
mized when close attention must be paid to more than one stimulus input.
19
Memory-Locatlon. It was not anticipated that the schizophrenic patients
would have significantly more difficulty on these tasks than the medical
patients. Both of these tasks are not timed and the given set is rather
simple.
Seashore Rhythm Test. It was hypothesized that this test would prove
to be of an intermediate level of difficulty for schizophrenic patients
as compared to the medical patients. Probably the greatest problem
encountered by the schizophrenic patients should be the requirement of
sustained attention.
Speech Perception Test. This task does not require any changes of set
and deals with a narrow range of stimulus input. Therefore it was not
believed that schizophrenic patients would have significantly more
difficulty on this task than medical patients.
Finger Oscillation. This test is not a complex one and would appear
to be rather purely dependent upon motor speed. It was not anticipated
that schizophrenic patients would have a significantly poorer per
formance than the medical patients.
Trails A and Trails B CTMT1. It was not anticipated that Trails A
would be more difficult for the schizophrenic patients than the medical
patients. However Trails B which requires integration of two symbolic
systems, numbers and letters, should be more difficult. Trails B has
more Irrelevant stimuli and requires constant shifting of set. It was
hypothesized that schizophrenic patients would perform significantly
poorer than the medical patients.
20
3. Does the pattern of scores on the Halstead-Reitan battery differ
for schizophrenic patients and brain-damaged patients? It was hypothe
sized that the overall pattern for the two groups would be different.
Based on Interference theory it was hypothesized that schizophrenic
patients would perform poorly on the Category Test, Tactual Performance
Test, and Trails B. Therefore it was hypothesized that schizophrenic
patients would not be significantly different from brain-damaged pa
tients on these tasks. Specific hypotheses concerning the performance
of the brain-damaged patients was rather difficult to make. This was
because any group of brain-damaged patients' performance depended to a
large extent on the sample selected. Location, recency of injury, and
type of pathology can significantly change the overall group perfor
mance by these patients.
4. Does type of schizophrenia (paranoid vs. nonparanoid) influence the
pattern of scores on the Halstead-Reitan battery? It was hypothesized
that the performance of the paranoid schizophrenic patients would be
significantly better than nonparanoid schizophrenic patients.
5. Does degree of symptomatology manifested on the MMPI influence the
pattern of scores on the Halstead-Reitan battery? It was hypothesized
that the schizophrenic patients with Low Symptomatology would perform
significantly better than the schizophrenic patients with High
Symptomatology.
6. Does interaction of type of schizophrenia and symptomatology change
the overall pattern of scores on the Halstead-Reitan battery? It was
hypothesized that the interaction would be significant with the Low
21
Symptom Paranoid Schizophrenic group performing significantly better
than the High Symptom Nonparanoid Schizophrenic group.
7. Can clinicians experienced in the interpretation of the Halstead-
Reitan battery significantly differentiate between the performance of
schizophrenic patients and brain-damaged patients? Although the
interpretation of the battery is primarily based on actuarial predic
tion, more subtle qualitative features of a patient's test performance
are also utilized. It was predicted that the three Judges would be
able to significantly distinguish between the two-patient groups, A
significant chi square at the .05 level of significance was used to
determine if judges could significantly differentiate between schizo
phrenic patients and brain-damaged patients.
METHOD
Subjects
A total of 60 patients comprised three groups tested on the
Halstead-Reitan Neuropsychological Test Battery. All patients were
under the age of 60 and were required to complete both the MMPI and the
entire Halstead-Reitan Neuropsychological Test battery.
The first group consisted of 24 male schizophrenic Inpatients.
This group was subdivided into two equal groups; one of 12 paranoid
schizophrenic patients and the other consisting of 12 nonparanoid
schizophrenic patients. For inclusion in either of these groups a
diagnosis of schizophrenia was made by the attending psychiatrist and
another staff member, usually the staff psychologist. In addition
each patient manifested at least two of six symptoms posited by Lorr
(1962) as unique to schizophrenia. Presence of these symptoms was
judged by the attending psychiatrist and one other staff member, usually
the staff psychologist. A list of these symptoms and their definition
is given in Appendix A. In addition no schizophrenic patient was in
cluded that had been diagnosed as being alcoholic or had a history of
heavy alcohol intake. Finally no schizophrenic patients were included
that had received EST within the last six months or who had ever had
over two series of EST in his history.
A total of 59 (837.) out of 71 schizophrenic patients were able
to complete the MMPI and were thus considered testable. Of the 12
schizophrenic patients who did not complete the MMPI 2 were illiterate,
23
5 were judged to be too psychotic, and 5 refused. Out of the remaining
59 schizophrenic patients an additional 18 patients were excluded
because they did not meet stated criteria. Five of the schizophrenic
patients were excluded because of positive evidence of brain damage.
Four were excluded because they had recently received or were currently
receiving EST. Nine schizophrenic patients were not tested because they
were known alcoholics or had histories of heavy alcohol intake. In
summary of the original 71 schizophrenic patients considered for
analysis 40 (57%) comprised the sample from which the final group of
24 schizophrenic patients were randomly drawn. Average length of
previous hospitalization for the schizophrenic patients was 8,1 months.
Additional clinical information on these patients is given in Appendix
B.The second group was composed of 18 Neurology or Neurosurgery
patients. No patient was excluded from this group because of lack of
cooperation. However several patients were excluded because of prior
or present evidence of psychosis or other physical problems that were
not related to their brain damage, but which would have interfered with
their performance on the Halstead-Reitan Test Battery. Types of brain
damage represented in this group were as follows: 10 cases of brain
trauma, 4 cases of vascular dysfunction, and 4 other cases that are not
easily categorized. Additional information and the specific diagnosis
of these patients is contained in Appendix C.
A third group was composed of 18 medical patients with no
evidence of neurological problems. During selection of these patients
24
It was necessary to eliminate one patient due to a history of psychosis.
Several other patients were not Included because they had been diagnosed
as being alcoholic or had a history of heavy alcohol intake. Only one
subject that was requested to participate refused. Additional clinical
information on patients in this group is contained in Appendix D.
Schizophrenic patients and medical patients were well matched in
terms of age, education, and IQ. Schizophrenic patients had the fol
lowing mean values on these variables; Age 28.00 (SD-8.38); Education
11.96 (SD*1.83); and WAIS IQ 99.08 (SD-11.83). Medical patients had
the following mean values; Age 32.44 (SD*10.85); Education 11.33 (SD*
2,57) and WAIS IQ 97.67 (SD*11.87). Brain-damaged patients were sig
nificantly different on these variables: Age 38.33 (SD“13.90);
Education 9.00 (SD-3.27); and WAIS IQ 85.28 (SD-12.63).
Assessment Instruments and Measures
The Halstead-Reitan Neuropsychological Test Battery consists of
five basic tests from which a total of seven measures are taken. The
number of measures on which the subject exceeds the established cut-off
points is multiplied by .143 to produce an over-all index of brain
dysfunction called the Impairment Index. The Time Sense Test was not
used in the present study because Reltan (1955b) and Vega and Parsons
(1967) found that this test had little practical value. Instead the
Trail-Making Test was substituted in that it is routinely utilized by
Reltan in the battery. Individual subtests in the battery are as follows;
25
Category Teat. The Category Teat consists of a projection apparatus
by means of which 208 nonverbal stimuli are presented on a screen.
Below the screen are four levers numbered 1-4. The subject is instruc
ted to push one lever after each stimulus presentation. Depression of
a lever causes either a bell or a buzzer to sound depending on whether
the lever represents a "correct" or "incorrect" response to the stimu
lus on the screen. From presented material, the subject is required to
abstract principles involving size, number, shape, etc., of the
stimuli around which responses are to be organized. The subject's
score, the number of wrong responses, depends upon the speed with
which he abstracts the correct principles. More than 50 errors is con
sidered to be suggestive of brain damage.
Tactual Performance Test (TPT). This test is a modification of the
Seguin-Goddard form board. While blindfolded the subject is required
to fit blocks into appropriate spaces on the board once with his right
hand, his left hand, and with both hands. The subject is then asked to
draw the outline of the board with blocks represented in their proper
places. The test is scored for total time required to place the blocks
on the board, memory (number of blocks accurately drawn) and localiza
tion (number of blocks correctly located in the drawing). A total
time greater than 15.40 minutes is considered to be in the brain damaged
range. A memory and localization score of less than 6 and 5 is con
sidered to be in the brain damaged range. In the present study subjects
were not allowed to work on the timed portion of the TPT for more than
fifteen minutes during any one of its three administrations.
26
Seashore Rhythm Teat. In this test subjects are required to identify
tape-recorded pairs of rhythmic beat sequences as "same" or "differ
ent." Five or more errors on this test are considered to be in the
brain damaged range,
Speech Perception Test. This test consists of sixty recorded nonsense
syllables. On each presentation the subject's task is to pick out the
recorded syllable from a series of four written nonsense syllables on
a printed test form.
Finger Oscillation. This test is a measure of finger tapping speed on
a key. Five ten-second trials are recorded with each index finger. An
average of less than 50 taps with the dominant hand is considered to
be in the brain damaged range.
Trail-Making Test. This test consists of two parts, A and B. Part A
consists of twenty-five circles distributed over a white sheet of
paper and numbered from one to twenty-five. The subject is required to
connect circles with a pencil-line as quickly as possible, beginning
with the first and proceeding in numerical sequence. Part B consists
of twenty-five circles numbered from one to thirteen and lettered from
A to L. The subject is required to connect circles alternating between
numbers and letters as he proceed in an ascending sequence. The score
obtained is the number of seconds required to complete the test. In
order to prevent some subjects from becoming overly tired, an arbitrary
time of six minutes was used as the cut-off point on each part. A rank
score greater than 1 on Part A and greater than 4 on Part B is consid
ered to be in the brain damaged range. This test does not contribute to the Impairment Index.
27
In addition to the seven measures which are used to compute the
Impairment Index the following supplementary tests to the Halstead-
Reitan Battery were administered, Wechsler Adult Intelligence Scale,
Lateralization Sensory Perception Test, and Aphasia Screening Test,
Four additional measures were taken from the Sensory Perception Test
and the Aphasia Test as follows:
Aphasia Screening Test. This test is basically a modification of the
Halstead-Wepman Aphasia Screening Test. It consists of 32 items that
are designed to test for a variety of "aphasic" problems. In the
present design total number of errors committed was used as a measure
of brain damage.
Finger Agnosia. In this test the patient must correctly identify
which finger has been touched by the examiner while blindfolded.
There is a total of 40 trials, 20 for the right hand and 20 for the
left hand. In the present design the total number of errors committed
was used as a measure of brain damage.
Finger-tip Number Writing. In this test the patient must correctly
identify while blindfolded a number that has been written on one of
his fingers. There is a total of 40 discriminations on this test. In
the present design the total number of errors made was used as a measure
of brain damage.
Tactile Form Recognition Test. In this test the patient must correctly
identify four geometric figures while blindfolded. There are a total
of 16 discriminations on the test. In the present design total number
of errors made was used as a measure of brain damage.
28
Procedure
All patients received the MMPI (Hathaway and McKinley, 1942)
and tfechsler Adult Intelligence Scale (Wechsler, 1958) from a member
of the psychology staff. Agreement on a diagnosis of paranoid or non
paranoid schizophrenia was agreed upon by the staff psychiatriet and
psychologist. In addition every schizophrenic included in the final
sample manifested at least two symptoms posited by Lorr (1962) as
unique to schizophrenia. Finally each schizophrenic patient was placed
into either a Low Symptom or High Symptom group depending on whether
their total T score on the Pa, Sc, Ma scales of the MMPI was above or
below 219. Difference in T scores between the schizophrenic patients
with Low Symptoms and High Symptoms on the MMPI was significant (T>
2.99, df“22, p .01). Thus nonparanoid and paranoid schizophrenic patients were relatively well equated in terms of symptomatology of the
MMPI. No schizophrenic patients were included in the final sample who
had any evidence of neurological impairment. In addition no schizo
phrenic patients were included who had been previously diagnosed as
alcoholic or who had a history of heavy drinking. Finally no schizo
phrenic patient was Included in the final sample who had had over two
series of EST or who had had EST within the last six months.
The brain damaged group was selected from the Neurology and
Neurosurgical wards. Patients included in this group all had positive
neurological and clinical evidence of brain damage, and no patients
were Included where the presence of brain damage was judged to be
equivocal by the neurologist.
29
The medical control group was selected from various medical
wards. All patients in this group were volunteers. There was no medi
cal evidence in their history that would indicate brain damage and each
attending physician certified that the patient was not brain damaged.
Analysis
To answer previously posed questions regarding group differences
on the Halstead-Reitan Neuropsychological Test Battery, a series of
multivariate analyses were performed. Multivariate analyses are par
ticularly useful in dealing with multiple measures on subjects. While
it is necessary to assume that a random sample of multivariate observa
tions had been collected from different individuals, it is not neces
sary to assume similar correlations aT..;ng the various variables across
cells. Thus multivariate analysis of variance provides a more exact
solution to analysis of variance problems than a simple analysis of
variance.
RESULTS
Analysis of All Measures on the Halatead-Reltan Battery Including Age and Education
The overall multivariate analysis o£ variance (using Wilks
Lambda Criterion) on measures on the three groups was significant
(multivariate F-2.63, p .001). This indicated that the pattern of
the scores was different for the three groups. Further univerate
analysis, as shown in Table 1, indicated that age and education were
significant measures across the three groups (£-7.37, 2/57 df, p
.001). Rhythms was the only measure that was not significant across
groups. Since age and education had a significant influence as
measured by the univariate F test, they were selected as covariates
in further analysis. Appendix E gives means and standard deviations
for all measures on the three groups. Appendix F gives means and
standard deviations for additional measures not included in the major
analysis. Figure 1 gives the z scores for all three groups.
Analysis of All Measures with Age and Education as Covariates
Results of multicovariate multivariate analysis of variance
on the twelve measures across the three groups are reported in Table
2. The overall pattern on these measures was significant (multivariate
F*2.92, p .001). Further univariate analyses Indicated that there
were significant differences across the three groups on all measures
with the exception of Rhythms. Adjusted means for the fourteen measures
with age and education as covariates are given in Appendix G.
Trails A 12.41 50.03 .001Trails B 9.03 43.33 .001Impairment Index 8.20 .43 .001
34
Analysis of the Halstead-Reitan Battery for the Medical Control Patients and the Brain Damaged Patients
The overall multivariate analysis of variance adjusted for age and education (using Wilks Lambda Criterion) on all measures for the medical and brain damaged group was significant (multivariate F-2,50, p .034). This indicated that the pattern of measures was different for the two groups. Further univariate analyses, as shown in Table 3 indicated that the only measure that did not significantly differentiate the two groups was Rhythms.
Analysis of the Halstead-Reitan Battery for the Medical and the Schizophrenic Patients
The overall multivariate analysis of variance (using Wilks Lambda Criterion) on all measures for the medical and schisophrenic patients was not significant (multivariate F«1.49, p .187). This indicated that the pattern of measures was not different for the two groups. Further univariate analysis, as shown on Table 4, indicated that the schizophrenic patients appeared to perform significantly poorer on the Category Test, the TPT, and Trails B.
Analysis of the Halstead-Reitan Battery for the Schizophrenic and Brain- Damaged Patients
The overall pattern on all measures was significantly different for the two patient groups (multivariate F-2.17, p .05). Further univariate analyses showed that schizophrenic patients and those with brain damage were not significantly different with regard to their performance on Categories, Location, Rhythms, and Trails B. The uni- varlat F test are reported in Table 5.
35
TABLE 3
ANALYSIS OF PATTERNS OF MEASURES FOR THE
MEDICAL AND BRAIN DAMAGED GROUPS
Variable Univariate FTests
F(l/32 df) MS
Categories 10.63 6195.93 .003
TPT 17.40 54935% .00 .001
Memory 8.20 27.95 .007Location 7.79 32.01 .009
Rhythms 2.33 22.27 .137
Speech Perception 5.87 378.76 .021
Tapping 12.68 1649.13 .001
Trails A 13.94 85.56 .001
Trails B 13.04 75.03 .001Impairment Index 14.96 .77 .001Aphasia Test 6.26 32.69 .018
Finger Agnosia 15.27 748.17 .001
Finger Tip Writing 31.78 1059.47 .001
Tactile Form Perception 8.59 116.52 .006
36
TABLE 4
ANALYSIS OF HALSTEAD-REITAN BATTERY FOR THE
MEDICAL AND SCHIZOPHRENIC PATIENTS
Variable Univariate F TeBts
F( 1/40 df) MS £
Category Test 7.47 4953.22 .009TPT 4.29 756096.88 .045
Tactile Form Per .28 . 17 3.33ception (Total Errors)
.58 .48 5.25
86
APPENDIX G
MEANS FOR ALL GROUPS ADJUSTED FOR
THE EFFECT OF AGE AND EDUCATION
Variable Medica1 Patients
SchizophrenicPatients
Brain Damaged Patients
Category Test (Errors)
53.06 78.71 81.00
TPT (Time in Minutes) 15.01 19.45 29.51
Memory(Errors) 2.48 3.22 4.50
Location(Errors) 5.42 6.92 7.40
Rhythms(Errors) 3.95 4.70 6.12
Speech Perception (Errors) 9.94 9.72 16.66
Tapping 50.84 48.75 36.65Trails A (Rank) 1.37 1.44 4.60
Trails B (Rank) 5.16 7.24 8.30
ImpairmentIndex .4-9 .579 .767Aphasia Test (Total Errors) 1.50 1.53 3.45
Finger Agnosia Test (Errors) .98 .39 10.56
Finger Tip Writing (Errors) 2.13 3.90 14.23
Tactile Form Perception (Errors) .15 - .16 3.90
VITA
James T. Stack was born on March 12, 1940, in Charlotte, North
Carolina. He is the elder of two children born to Mai A. and Ollie Mae
Stack. Following graduation from East Mecklenburg High School in 1958,
he attended the University of North Carolina, Chapel Hill, North
Carolina. After obtaining the degree of Bachelor of Arts in June,
1962, he was employed as a Public Health Advisor for the North Carolina
State Health Department for over a year. Following six months military
service in 1964 he returned to Chapel Hill and was employed in the
Human Genetic Laboratory in North Carolina Memorial Hospital. In
September 1965 he enrolled in the graduate school of Louisiana State
University where he was awarded the degree of Master of Arts in 1968,
He completed his clinical internship at the Veterans Administration
Hospital in New Orleans, Louisiana. He is a candidate for the degree
of Doctor of Philosophy at the May, 1971 commencement.
EXAMINATION AND THESIS REPORT
Candidate: JAMES T. STACK
Major Field: Psychology
Title of Thesis: Performance of Acute Paranoid and rbn-paranoid SchizophrenicPatients on the Halstead-Reiten Battery Using Two Levels of Symptomatology.